Thoughts and Feelings Taking Control of Your Moods and

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“For professionals and the public, this wonderful workbook, like a
wise teacher, can help make a positive difference.”
—Thomas F. Cash, PhD, professor emeritus of clinical
psychology at Old Dominion University in Norfolk, VA

“A jewel of a book: supportive and empathetic, short on platitudes

and long on practical applications. A must-buy for all cognitive
behavioral therapists.”
—Thomas E. Ellis, PsyD, ABPP, professor of psychology at
Marshall University in Huntington, WV
 Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject
matter covered. It is sold with the understanding that the publisher is not engaged in rendering
psychological, financial, legal, or other professional services. If expert assistance or counseling is
needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2021 by Matthew McKay, Martha Davis, and Patrick Fanning New Harbinger
Publications, Inc. 5674 Shattuck Avenue Oakland, CA 94609 www.newharbinger.com
All Rights Reserved
Acquired by Jennye Garibaldi
Cover design by Amy Shoup
Text design by Tracy Marie Carlson

Library of Congress Cataloging-in-Publication Data

Names: McKay, Matthew, author. | Davis, Martha, 1947- author. | Fanning, Patrick, author.
Title: Thoughts & feelings : taking control of your moods & your life / Matthew McKay, Martha
Davis, Patrick Fanning.
Other titles: Thoughts and feelings
Description: Fifth edition. | Oakland, CA : New Harbinger Publications, Inc., [2021] | Includes
bibliographical references and index.
Identifiers: LCCN 2020030375 (print) | LCCN 2020030376 (ebook) | ISBN 9781684035489 (trade
paperback) | ISBN 9781684035496 (pdf) | ISBN 9781684035502 (epub)
Subjects: LCSH: Cognitive therapy--Popular works.
Classification: LCC RC489.C63 M34 2021 (print) | LCC RC489.C63 (ebook) | DDC 616.89/1425--
dc23
LC record available at https://lccn.loc.gov/2020030375
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 PREFACE TO THE FIFTH EDITION

The first edition of Thoughts and Feelings appeared in 1981. It was an

introduction to cognitive behavioral therapy that was used by general readers
and therapists alike. It provided simple, step-by-step instructions for a dozen
specific techniques.
Over the years we came to realize the book’s limitations. To begin with,
some of the techniques had not stood the test of time. Later studies had shown
them to be less effective than newer, more powerful interventions. In addition,
although cognitive behavioral therapists were developing multistep protocols
to treat many disorders, the original edition of Thoughts and Feelings didn’t
show how to link a series of techniques together into an integrated treatment
plan for problems like depression, panic disorder, or anger.
With subsequent editions of Thoughts and Feelings, the book has been
revised to include more effective methodologies and reflect changes in modern
practices. Thoughts and Feelings now offers multistep treatment plans for
many mood-based problems. These plans are outlined in chapter 1 to show you
a sequence of relevant chapters and techniques for each disorder. This is
consistent with the way cognitive behavioral treatments are conducted during
therapy: You take a series of steps to acquire skills that serve as building
blocks in coping with problems. For this edition, we have revised the chapters
on worry control, getting mobilized, and brief exposure and added new
chapters on self-compassion and habit reversal.
As always, our intention with this edition is for both the general reader
and the therapist to use this book. The general reader will find that each
treatment protocol has clear, easy-to-follow steps that provide tools for
genuine self-help. Therapists will find the book to be a resource for the most
effective treatment methods, as well as a helpful take-home manual for clients.
Thoughts and Feelings was written because life is hard. To cope, all of us
have been given a random set of tools and instructions by parents, family,
friends, teachers, bosses, and others. Some of this has been helpful, some not.
Thoughts and Feelings is about tools that work. It is a guide for changing old
patterns of responding in order to take control of your moods and your life.

—Matthew McKay

—Patrick Fanning

—Martha Davis
 ACKNOWLEDGMENTS

Grateful acknowledgment is made to Norman Cavior, PhD, our teacher, and

the one who first introduced us to cognitive behavioral techniques. He
continues to be a source of wisdom and inspiration.
 HOW TO USE THIS BOOK

We’ve chosen to present cognitive behavioral techniques in a workbook format

so you can practice them as self-­help steps toward change. People in the
helping professions—­therapists, doctors, nurses, social workers, even teachers
and supervisors—­will find many of these techniques useful in their personal
lives, and also of value to clients, patients, students, or employees.
In chapter 1 you’ll find a list of twelve major problems and a specific,
step-­by-­step treatment plan for each of them. The treatment plan will give you
the sequence in which to work through relevant chapters and techniques. At
the end of chapter 1 is the Treatment Planner chart, which gives an overview
of which chapters you should read to treat these and a few other problems.
In most cases you’ll find it helpful to read chapters 2, 3, and 4 first,
because they represent the foundation of cognitive behavioral therapy. You’ll
learn how thoughts influence feelings and how habitual negative thoughts can
impact your mood. You’ll also find tools for changing your thoughts in order
to relieve anxiety, depression, and anger.
The full benefits of cognitive behavioral therapy can be realized only
through regular practice over time. Simply understanding a technique is of
little value without firsthand experience. In other words, this is not a book for
passive reading. You have to do the exercises, fill in the worksheets, and carry
out real changes in how you think and behave.
The length of time required to practice a particular technique will vary.
See the “Time to Mastery” sections for an idea of the time required to develop
each new skill. Because regular practice is the key to successful change,
practice the exercises daily. Some of the techniques will need to be
“overlearned” so they become automatic responses. The goal is to be able to
use the techniques wherever and whenever you need to, without having to
refer to the book.
If you feel you have limited self-­discipline or are not highly motivated,
try these two alternatives:
 1. Make a contract with another person, as described in chapter 23, to
reinforce your commitment to learning and using the relevant
techniques in this book.
2. Seek a consultation with a cognitive behavioral therapist to help you
develop and monitor your treatment program.

Before undertaking any cognitive behavioral treatments for anxiety, you

should get a complete physical checkup. Have your doctor rule out thyroid
problems, hypoglycemia, mitral valve prolapse, and other cardiac arrhythmia
problems. If you experience any prolonged physical effects while doing
exercises in this book, consult your physician.
 CHAPTER 1:

Making Your Own Treatment Plan

You’re probably reading this book because you’re feeling bad. You may be
depressed, anxious, angry, worried, confused, frustrated, upset, ashamed…
Unfortunately, the list is very long. Please remember that you are not alone or
unusual in your struggle with painful feelings and experiences. Everybody
experiences emotional distress sometimes. It’s normal.
When the pain becomes too strong and too enduring, it’s time to do
something about it. By reading this book, you are taking an important first step
toward feeling better.
When you feel bad, you don’t have the time and patience to wade through
simplistic pep talks, unrealistic success stories, needless horror stories, or long-
winded and obscure discussions of theory. Therefore, we have made this book
as clear and as brief as possible.
On the other hand, when you feel bad you don’t have the energy to seek
out partial fragments of the solution to your problem in widely scattered
locations. So we’ve also made this book as complete as possible. Everything
you need to learn the techniques in this book is presented in detail, proceeding
logically, step-by-step.
If you are in pain, you also don’t have any time to waste on unproven
remedies of doubtful utility. Therefore, we have included only techniques that
have been proven to have strong therapeutic benefits in many well-designed
studies with many different types of people, and over a long period of time.
Over the past thirty years, many new cognitive behavioral techniques
have been developed and refined to relieve anxiety, lift depression, and calm
anger. The best of these techniques are presented in this book. They offer you
real promise that help is on the way. With patience and a little effort, you can
start to feel better soon.

WHY COGNITIVE BEHAVIORAL THERAPY

WORKS
Many people believe that painful feelings are caused by forgotten childhood
experiences and that the only way to relieve these feelings is through long,
difficult analysis to root out unconscious memories and associations.
There is undoubtedly some connection between your distant past and
painful feelings in the present. But modern cognitive behavioral therapists
have discovered a much more immediate and accessible source of emotions:
your current train of thought. It has been demonstrated over and over again
that most painful emotions are immediately preceded by some kind of
interpreting thought.
For example, a new acquaintance doesn’t telephone when he said he
would. If your interpreting thought was “He doesn’t like me after all,” you
would feel sad at being rejected. If your thought was “He’s been in a car
crash,” you would feel anxiety for his well-being. If you thought, “He
deliberately lied to me about calling,” you might feel anger at his falsehood.
One simple insight forms the heart of cognitive behavioral therapy: You
can change your feelings by changing your thoughts. Hundreds of studies over
the last thirty years have proved that this simple insight can be applied to
relieve a large variety of problems more easily and quickly than any other
therapeutic technique.

DESIGNING YOUR TREATMENT PLAN

This is not the kind of book that you must read cover to cover. This chapter
will help you assess your problem and plan which chapters to work through to
solve your problem.
Twelve major emotional problems and the plans to treat them are
summarized below. The treatment plans follow a definite sequence, beginning
with the most useful or general technique and proceeding to more specialized
interventions.
For each problem below, we begin by discussing characteristic symptoms.
Then the pertinent chapters are listed in the order in which they should be read.
Each section concludes with a brief description of the steps and rationale for
the protocol.
If you’d like an overview of all the problems this book treats, see the
Treatment Planner chart at the end of this chapter. It shows, at a glance, all of
the treatment for each of the problems discussed below.

Worry
Worry is the main symptom of generalized anxiety disorder. You have a
problem with worry if you have been excessively apprehensive more days than
not for at least six months. Seriously anxious people find it difficult to control
their worry and typically experience these symptoms:

Restlessness
Fatigue
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance

Treat worry by working through the following chapters in order:

Chapter 5, “Relaxation”
Chapter 6, “Worry Control”
Chapter 21, “Problem Solving”

Begin at chapter 5, “Relaxation” and emphasize practicing cue-controlled

relaxation. In chapter 6, “Worry Control,” you’ll learn how to make an
accurate risk assessment, do worry exposure, and achieve worry behavior
prevention. Because some worries can be addressed by searching for
alternative solutions, chapter 21, “Problem Solving,” will be helpful, as it
teaches skills for finding new answers. If worry persists due to deeply held
negative beliefs, read chapter 15, “Testing Core Beliefs.” Chapter 9,
“Mindfulness,” may help you focus on the here and now, which can also help
ease worry, and chapter 10, “Defusion,” will help you detach from worry-
provoking thoughts.

PANIC DISORDER
Panic is a period of intense fear. When you experience a panic attack, you feel
some of the following symptoms very intensely, and they’ll reach a peak
quickly—within ten minutes:

Pounding heart and fast heart rate

Sweating
Trembling
Shortness of breath
A feeling of choking
Chest pain
Stomach pain or nausea
Feeling spacey
Fear of losing control or “going crazy”
Fear of dying
Numbness or tingling
Chills or suddenly feeling hot or flushed

Treat panic disorder by working through the following chapter:

Chapter 7, “Coping with Panic”

Follow all of the steps outlined in chapter 7, “Coping with Panic.” You’ll
need to master breath control training, learn how to use a Probability Form,
and practice interoceptive desensitization.
If you haven’t developed agoraphobia (fear of being away from a safe
place) or significant avoidance because of the fear of panicking, chapter 7 will
be sufficient. However, if you’ve reached a point where you are avoidant or
agoraphobic, you’ll need to develop a fear hierarchy as explained in chapter
13, “Brief Exposure,” and work through chapter 14, “Prolonged Exposure,” so
you can begin exposing yourself to your feared situations in gradual steps.
Chapter 9, “Mindfulness,” can help you observe your symptoms, moment
to moment, as transitory, nonfatal phenomena.

Perfectionism
When you struggle with perfectionism, nothing is ever good enough.
Shades of gray disappear and you see only black and white—mostly black.
You are your own harshest critic, constantly upbraiding yourself for failing to
come up to the mark. You may spend hours checking and rechecking
calculations, revising a paper, or sanding and polishing a craft project. Yet all
of this striving for perfection doesn’t please you; it only makes you all the
more anxious about making mistakes and being criticized for them.

Treat perfectionism by working through the following chapters in

order:

Chapter 2, “Uncovering Automatic Thoughts”

Chapter 3, “Changing Patterns of Limited Thinking”
Chapter 4, “Changing Hot Thoughts”
Chapter 6, “Worry Control” (worry behavior prevention only)
Chapter 15, “Testing Core Beliefs”

Begin with chapters 2, 3, and 4 to develop skills in using the Thought

Journal. Pay attention to limited thinking patterns, particularly polarized
thinking, catastrophizing, magnifying, and shoulds. In chapter 4 you’ll also
learn how to confront hot thoughts (the thoughts that trigger emotion) about
the seemingly dire consequences of making mistakes.
 The program for worry behavior prevention in chapter 6 is critical for
limiting the excessive checking and overworking that grow out of fears of
making mistakes or being criticized. Chapter 15, “Testing Core Beliefs,” will
give you tools to identify and change deeply held beliefs about unworthiness
and incompetence that may fuel your perfectionism.
If you still have serious problems with perfectionism after working
through chapter 15, see chapter 13, “Brief Exposure,” to develop a hierarchy
of feared mistakes, then expose yourself through imagery to each step of your
hierarchy. You will also need to expose yourself to mistakes in real life by
deliberately making mistakes in a series of planned experiments (see “Step 6:
Test Your Rules,” in chapter 15).

Obsessional Thinking
Obsessional thinking consists of recurrent thoughts, impulses, or images
that intrude on your consciousness. Obsessional thinking is not ordinary worry
over a current problem; it’s a disturbing, unwelcome train of thought that is
excessive, unreasonable, and time-consuming. You try to stop obsessing, but
the thoughts soon start up again. Obsessional thinking can significantly
interfere with your normal routine at home, school, or work.

Treat obsessional thinking by working through the following chapters

in order:

Chapter 10, “Defusion”

Chapter 14, “Prolonged Exposure”
Chapter 6, “Worry Control” (worry behavior prevention only)

The protocol for obsessional thinking starts with chapter 10, “Defusion,”
because it’s simple and easy to learn. This technique will allow you to detach
from many unwanted thoughts. But there will be some thoughts—usually
those that trigger very high anxiety—that will require a more powerful
strategy. Chapter 14, “Prolonged Exposure,” shows you how to bombard
yourself with images derived from your obsessional thoughts and in so doing
take away their power.
 The section on worry behavior prevention in chapter 6 helps you stop any
checking or avoidance behaviors that reinforce your obsessions. Finally,
chapter 18, “Self-Compassion,” is an optional process that can soften urgent or
attacking obsessional thoughts.

Phobia
Phobias are generally classified into three main categories: specific
phobias, agoraphobia, and social phobia. Specific phobias include excessive or
unreasonable fear of such things as flying, heights, animals, injections, blood,
and so on. You avoid the object of your fear as much as possible. If you must
fly, ascend heights, or approach feared animals, it causes you intense anxiety,
perhaps a full-blown panic
attack. Specific phobias go beyond normal caution in risky situations.
They seriously interfere with your relationships, daily routine, schooling, or
career.
Agoraphobia is anxiety about or avoidance of public places. People with
agoraphobia fear leaving a safe place, such as their home. They don’t want to
be in a situation in which escape would be difficult or embarrassing. They are
often concerned about having a panic attack someplace where help isn’t
available. People with agoraphobia typically fear being outside their home
alone, being in a crowd, standing in line, crossing a bridge, traveling in a bus
or train, and so on.
Social phobia is a strong, persistent fear of being with unfamiliar people.
If you have social phobia, you try to avoid situations in which you must meet
new people, interact with those you don’t know well, or face the scrutiny of
strangers. You’re afraid you may behave awkwardly or embarrass yourself by
showing how anxious you are. When you must be in social situations, you’re
very anxious, even though you realize your fear is excessive. Social phobia
seriously interferes with your life.

Treat phobia by working through the following chapters in order:

Chapter 7, “Coping with Panic” (only if you have agoraphobia)

Chapter 5, “Relaxation”
 Chapter 13, “Brief Exposure”

The basic treatment protocol for all phobias is the same, with the
exception of agoraphobia. Agoraphobia usually starts with untreated panic
disorder. The panic disorder must be resolved first by working through chapter
7, “Coping with Panic.” Then you can continue with the regular phobia
protocol.
To use the regular phobia protocol, initially work through chapter 5,
“Relaxation.” Then work with chapter 13, “Brief Exposure,” to develop a fear
hierarchy, expose yourself to those situations using visualization, and then
practice brief exposure in real-life situations.
If brief exposure doesn’t completely resolve the phobia, move on to
chapter 14, “Prolonged Exposure,” which emphasizes long periods of
visualized or real-life exposure. If you’re working through this protocol for a
social phobia, you might also wish to explore chapter 9, “Mindfulness,”
chapter 19, “Covert Modeling,” or chapter 8, “Coping Imagery,” to develop
and practice a specific plan for handling novel social situations.

Depression
When you’re depressed, your mood is sad and nothing seems interesting
or pleasurable. It can affect your appetite, causing you to lose or gain weight.
You might sleep a lot more or less than usual. You feel restless and yet tired at
the same time. It’s hard to concentrate or make decisions, especially the
decision to get up and do something. You feel worthless. Life seems hopeless.
Thoughts of death are common, and you may even think about suicide. One
very important note: If you have serious thoughts of suicide, this book is not
enough. You need to see a mental health professional as soon as possible.

Treat depression by working through the following chapters in order:

Chapter 12, “Getting Mobilized”

Chapter 2, “Uncovering Automatic Thoughts”
Chapter 3, “Changing Patterns of Limited Thinking”